Provider Demographics
NPI:1518098292
Name:STANLEY, GARRIT E (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRIT
Middle Name:E
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SMOKEY POINT DR STE J
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-7707
Mailing Address - Country:US
Mailing Address - Phone:360-653-5960
Mailing Address - Fax:360-653-4743
Practice Address - Street 1:3131 SMOKEY POINT DR STE J
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7707
Practice Address - Country:US
Practice Address - Phone:360-653-5960
Practice Address - Fax:360-653-4743
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0067046OtherL AND I PROVIDER NO
WAR23416OtherREGENCE RIDER NO
WA1831205Medicaid
WA0067046OtherL AND I PROVIDER NO